Novel Immunotherapy Approaches to Food Allergy

Simone M. Hayen; Atanaska I. Kostadinova; Johan Garssen; Henny G. Otten; Linette E.M. Willemsen

Disclosures

Curr Opin Allergy Clin Immunol. 2014;14(6):549-556. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Despite reaching high percentages of desensitization using allergen-specific immunotherapy (SIT) in patients with food allergy, recent studies suggest only a low number of patients to reach persistent clinical tolerance. This review describes current developments in strategies to improve safety and long-term efficacy of SIT.

Recent findings Modified allergens or tolerogenic peptides, ultimately optimized for human leukocyte antigen background of the patient, are explored for tolerance induction, whereas anti-IgE antibody (Omalizumab) may be used to facilitate SIT safety. Adjunct therapies to enhance efficacy may make use of TH1 polarizing agents, for example, CpG-oligodeoxynucleotides combined with modified allergen packaged in nanoparticles. Preclinical studies showed insulin-like growth factor-2, intravenous immunoglobulin, Tregitopes or allergen encased oligomannose-coated liposomes capable of inducing regulatory T-cells, recognized for their importance in clinical tolerance induction. Dietary intervention strategies utilizing herbal formula 2, VSL#3, nondigestible short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS) plus Bifidobacterium breve M-16V or n-3 long-chain polyunsaturated fatty acids may facilitate safety and/or a favourable milieu for tolerance induction.

Summary Combining SIT using (adapted) allergens or tolerogenic peptides with adjunct therapy may be essential to improve safety and/or efficacy. Beyond using targeted approaches, specific dietary components may be explored to reduce side-effects and support clinical tolerance induction by SIT.

Introduction

The rising prevalence of allergic diseases relates to the increase in noncommunicable diseases, and food allergy may be seen as an early onset noncommunicable disease.[1] Food allergy is one of the first manifestations of atopic constitution and affects 6% of children and 3 to 4% of adults in westernized countries. Cow's milk and hen's egg are the main contributors to early childhood allergy and are outgrown in 80% of patients, by contrast, peanut allergy is resolving in less than 20%. Intake of the culprit food results in local (oropharyngeal/gastrointestinal) and/or systemic (atopic dermatitis, asthma) symptoms, ranging from mild (itching) to extremely severe (anaphylactic shock). Food allergen-specific immunotherapy (SIT) is being explored, but safety and long-term efficacy issues currently question its applicability for general clinical practice.[2,3] This review provides an update on clinical trials published over the last year using SIT in IgE-mediated cow's milk, hen's egg and peanut allergy. Furthermore, novel developments in allergen modification and adjunct therapies to improve safety and (long-term) efficacy are discussed.

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